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  • Response to: ‘Correspondence on: irritable bowel syndrome symptoms in axial spondyloarthritis more common than among healthy controls: is it an overlooked comorbidity?’ by Proft et al.

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Correspondence response
Response to: ‘Correspondence on: irritable bowel syndrome symptoms in axial spondyloarthritis more common than among healthy controls: is it an overlooked comorbidity?’ by Proft et al.
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  1. Johan Karlsson Wallman1,2,
  2. Elisabeth Mogard1,2,
  3. Jan Marsal3,4,
  4. Kristofer Andréasson1,2,
  5. Anna Jöud5,
  6. Mats Geijer6,7,
  7. Lars Erik Kristensen8,
  8. Elisabet Lindqvist1,2,
  9. Tor Olofsson1,2
  1. 1 Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
  2. 2 Department of Rheumatology, Skåne University Hospital Lund, Lund, Sweden
  3. 3 Department of Clinical Sciences Lund, Gastroenterology, Lund University, Lund, Sweden
  4. 4 Department of Gastroenterology, Skåne University Hospital Lund, Lund, Sweden
  5. 5 Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
  6. 6 Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland and Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
  7. 7 Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden
  8. 8 Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Parker Institute, Copenhagen, Denmark
  1. Correspondence to Dr Johan Karlsson Wallman, Department of Rheumatology, Skåne University Hospital Lund, 22185 Lund, Sweden; johan.81.karlsson{at}gmail.com

https://doi.org/10.1136/annrheumdis-2019-216752

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    We appreciate the correspondence by Proft et al regarding our study entitled ‘Irritable bowel syndrome symptoms in axial spondyloarthritis more common than among healthy controls: is it an overlooked comorbidity?’,1 2 and thank Annals of the Rheumatic Diseases for the opportunity to respond. We also acknowledge the major contributions of Proft et al to the field of spondyloarthritis (SpA) research.

    Regarding our main result, that irritable bowel syndrome (IBS) symptoms are significantly more common among patients with axial SpA without known inflammatory bowel disease (IBD) (n=182) than in healthy controls (n=50), Proft et al point out that the increased prevalence is likely due to other causes than actual clinical IBS (in particular gut inflammation and side effects of non-steroidal anti-inflammatory drug (NSAID) use).

    In response to this, we would first like to draw attention to the rule-out character of the ROME III criteria used to diagnose IBS, as also brought up by Proft et al. According to these, a clinical IBS diagnosis requires both a typical constellation of gastrointestinal symptoms, as defined by the criteria, and the exclusion of organic causes such as IBD or malignancies. The main finding of our study, that 30% of the axial SpA patients in the well-characterised SPARTAKUS cohort reported IBS symptoms, as opposed to 16% of healthy controls (sex/age-adjusted OR 2.5; p=0.036), refers to self-reported symptoms, as defined by the ROME III criteria, but irrespective of their underlying cause (and hence not per se meeting the exclusion condition). This important distinction—between IBS symptoms and a clinical IBS diagnosis—is made throughout our report.

    In the second part of our study, we then performed a hypothesis-generating analysis of potential drivers behind the observed IBS symptoms. Similar to Proft et al …

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